Face transplantation: A longitudinal histological study focusing on chronic active and mucosal rejection in a series with long-term follow-up

Abstract

The 2007 Banff working classification of skin-containing Tissue Allograft Pathology addressed only acute T cell-mediated rejection in skin. We report the longitudinal long-term histological follow-up of six face transplant recipients, focusing on chronic and mucosal rejection. We identified three patterns suggestive of chronic rejection (lichen planus-like, vitiligo-like and scleroderma-like). Four patients presented lichen planus-like and vitiligo-like chronic rejection at 52 ± 17 months posttransplant with severe concomitant acute T cell-mediated rejection. After lichen planus-like rejection, two patients developed scleroderma-like alterations. Graft vasculopathy with C4d deposits and de novo DSA led to subsequent graft loss in one patient. Chronic active rejection was frequent and similar patterns were noted in mucosae. Concordance between 124 paired skin and mucosal biopsies acute rejection grades was low (κ = 0.2,

Defining chronic rejection in vascularized composite allografts – do we have reliable surrogates to look for?

“…Of note, pathologic changes of CR in the skin (including papillary dermal sclerosis with superficial hyalinization, epidermal thinning with loss of rete ridges and perieccrine fibrosis) have been observed in the absence of GV and involvement of muscles, adipose tissue, and bone, suggesting that CR can occur in the absence of GV [23]. Pathologic changes similar to those observed in the skin are also observed in the nasal and oral mucosa of FA [12 ▪ ,25], including vitiligo-like changes (due to the loss of melanocytes), a lichen planus-like aspect of the epithelium (epidermoid metaplasia with a stratum granulosum and corneum) and dense fibrosis in the chorion, with loss of minor salivary glands, even though the concordance of the severity grade between the skin and mucosa was reportedly moderate [12 ▪ ].…”

“…Pain [10] or alopecia [13] may be the presenting signs of CR in UEA and FA, respectively, and nail changes may be seen in CR in UEA [17]. On the basis of these presentations, three clinical patterns of CR were individualized in FA, including vitiligo-like, lichen planus-like and scleroderma-like CR [12 ▪ ]. Additional clinical findings that have been described in FA include cutaneous rhagades, facial laxity and wrinkling (simulating chronological aging) and white demarcation of the suture lines and telangiectasias [11 ▪ ].…”

“…CR is as a rule irreversible, and often leads to graft loss [5]. In human VCA, several cases of CR have been observed in recent years [6–8,9 ▪ ,10,11 ▪ ,12 ▪ ,13]. According to data included in the International Registry of Hand & Composite Tissue Transplantation, CR has been reported in 13.5% of VCA recipients; the 10-year survival of UET allografts reaches 87% [14].…”

TRFs and tiRNAs sequence in acute rejection for vascularized composite allotransplantation

“…VCA is used to repair large-area defects that cannot be achieved by traditional reconstruction techniques. Some believe that VCA technology remains experimental, but some cases of very successful hand and face transplantation using VCA surgery have been reported 1 , 2 . To prevent rejection after the operation, recipients usually receive routine immunosuppressive therapy.…”

Potential Roles of miRNAs in Acute Rejection for Vascularized Composite Allotransplantation

“…The development of microsurgery has greatly increased the application of VCA, several cases of successful hand and face VCA surgery have been reported. 1 , 2 Organ recipients routinely receive immunosuppressive therapy after transplantation to prevent rejection. However, some patients still experience acute rejection after immunosuppressive therapy.…”